<include file="public@head_top"/>
</head>
<body class="bgeee">
<include file="public@head"/>
<style>
@media (max-width: 768px) {
	.formInner .right{ float:left;}
}
</style>

<div class="sample">
    <div class="sampleW">
        <div class="sampleH">
            <h2>{$configlang['Free_sample_collection']}</h2>
            <div class="line"></div>
        </div>
        <style>.formInner{ position:relative;}.formInner label.error{     font-size: 14px;color: red;position: absolute;right: 20px;top: 0;}.classtypeblock{ text-align:center; margin-bottom:20px; font-size:18px;}</style>
        <form id="feedbackformblock" action="#" method="post" class="js-ajax-form st-block">
            {$fbackparameter}
            <div class="formInner formYzmInner clearfloat" >
                <div class="formW formYzmW">
                    <p>{$configlang['Verification_code']}<span>*</span></p>
                    <input class="formYzm" type="text" name="captcha" placeholder="验证码">
                </div>
                <a href="javascript:"><captcha height="38" width="160" font-size="20"/></a>
                <h4>{$configlang['Can_t_see_clearly']}</h4>
            </div>
            
            <div class="hint">
                <p></p>
            </div>
            
            <div class="formB clearfloat">
                <input type="hidden" value="insert" name="act">
                <button class="formSure">{$configlang['submit']}</button>
                <button class="formReturn" type="reset">{$configlang['Reset']}</button>
            </div>
            
        </form>
        <script>
		Wind.use("validate", function () {
			//自定义validate扩展
			$.extend(jQuery.validator.messages, {
					required: ""// 不能为空
			});
			$("#feedbackformblock").validate({
				rules: {
				  {$configsystem['columnparametercodeqzstr']}
				},
				messages: {
				  {$configsystem['columnparametercodeqzstrtip']}
				}
			});
		});
		</script>
    </div>
</div>

<include file="public@footer"/>
</body>    
</html>